China’s AIDS policy taking a deadly toll

NEW YORK — China’s decision to bar Dr. Gao Yaojie from attending an award ceremony in the United States is the latest example of the Chinese government’s mistaken policy on AIDS. Taken together with other policies, it shows that by trying to avoid publicity about AIDS and ignoring the rapid spread of HIV, the government is contributing to the spread of the disease rather than to its elimination.

Unless there is a dramatic change in Beijing’s AIDS policy, the spread of HIV will have a devastating impact on the health of the Chinese people and on the country’s economy.

Gao, the third winner of the Jonathan Mann Award for Health and Human Rights from the Global Health Council — a non-profit organization based in the U.S. — was to have received the award at a ceremony hosted by U.N. Secretary General Kofi Annan. The award was a recognition of the doctor’s efforts to combat the spread of HIV among poor farmers in Henan Province, an agricultural region in central China. The situation of AIDS in Henan, which has a population of 90 million, has become a focus of attention for public-health experts.

In Henan, as well as in many other rural areas throughout China, most HIV-positive farmers became infected by selling their blood at collection stations that lacked even minimal safety procedures. At illegal blood stations in particular, blood is collected at one time from a number of donors who share the same blood type. Afterward, the blood is pooled, the components needed for medical use are separated and the remaining blood is divided up and re-infused into the original donors. This unsafe procedure exposes people to the blood of 6 to 12 other donors every time they donate, facilitating the spread of not only HIV but hepatitis and other serious diseases.

Although China has achieved success in several public-health areas, including nutrition and the systematic monitoring and elimination of endemic and epidemic diseases, sexually transmitted diseases and HIV are still taboo subjects that have not been properly addressed. In the case of HIV, chronic blood shortages have created huge demands, leading to the establishment of underground collection centers. “Blood pimps” working for these centers have little problem finding 50 to 60 donors at any given time.

Experts believe the factors causing the rapid spread of HIV include China’s massive migrant population, people’s lack of knowledge of the disease, the existence of drug abuse and prostitution, the growing number of people with venereal diseases — which facilitate the spread of HIV — and unsafe blood transfusions.

In addition, secrecy and the inability of the central government to implement effective policies in the provinces, as well as lack of accountability and corrupt government officials, aggravate the problem. As a result, the pace at which HIV has been spreading in China has accelerated markedly in the last few years.

Although the Chinese government maintains there are only 22,517 HIV-infected people, public-health experts estimate that the true number may easily be over one million. In spite of that, in 1999, China’s budget for AIDS prevention was only a few million dollars, an amount much lower than that of smaller countries such as Vietnam or Thailand.

A report by a committee of Chinese experts presented to the Chinese leadership earlier this year stated, “Owing to government indifference, AIDS prevention and control is gravely ineffective.”

Several cities have declared “indecent” billboards promoting prevention through the use of condoms and ordered them destroyed. In addition, television ads promoting the use of condoms have been removed from the air.

Slowing the spread of HIV requires several actions: an acknowledgment by public health and government officials of the seriousness of the situation, massive education campaigns on ways of preventing HIV transmission, safe conditions for blood donations and the provision of sterile syringes to control the spread of HIV among drug addicts.

Unless Chinese authorities remedy the current situation, they will realize that their true enemy is not outside their borders but inside their own country.